In March 2016, 43 Milestone therapists and assistants attended “Clinical Pathways for Successful Orthotic Contracture Management Therapy” taught by John Kenney. The course included instruction in NeuroStretch, a technique that stimulates the Golgi tendon organ at the muscle-tendon junction and creates an inhibitory effect on the muscle.

This technique can be used effectively with neuro-contractures where there is a neurological opposition to stretch and adaptive tissue shortening. Contractures can lead to skin breakdown, increased difficulty with personal care and hygiene, impaired mobility and increased pain. The following illustrates the results of incorporating NeuroStretch with a 35-year-old sub-acute resident.

NeuroStretch Case Study

The resident has a history of a TBI with resultant spastic quadriplegia. He had developed progressive contractures in the bilateral elbows, wrist, fingers and ankles.

Intervention included:

  • Assessment of resting position and tone using the Modified Ashworth Scale
  • Application of moist heat
  • Use of NeuroStretch PROM/low load prolonged stretch followed by application of a splint (modified as needed) for two to four hours, five times per week
  • Training of RNA staff in using the NeuroStretch technique and proper application of splints
  • Follow-up and re-evaluation post-treatment to evaluate splints and modify as needed

Results

Using NeuroStretch, the patient’s left elbow flexion contracture improved PROM by 18 degrees, while the right plantar flexion contracture improved PROM by 25 degrees. Factors impacting results included different clinicians measuring PROM and two different RNAs performing PROM and don/doffing splints. We also noted that our resident’s PROM was affected by visual external cues, so we were careful to create an environment conducive to relaxation.

Conclusion

Based on this case study, we have concluded that communication and collaboration between therapy, RNA and nursing is important for effectively managing contractures. Having one designated RNA doing all PROM for residents (with carryover of weekend CNA staff) produced the best results. To ensure the greatest success, our therapy team works collaboratively with the entire clinical team in managing contractures.

Submitted by St. Joseph Villa, Salt Lake City, UT